Utah's 2026 General Session introduced several significant changes affecting provider directories, insurance coverage requirements, autism services, and physical therapy cost‑sharing. Below is a summary of key bills and their potential implications for providers participating in our Medicaid network.

H.B. 71 – HEALTH PROVIDER DIRECTORY AND ACCESS AMENDMENTS

H.B. 71 focuses on improving member access to behavioral health services and strengthening oversight of insurer provider directories. Key provisions require insurers to maintain accurate, publicly accessible provider directories and promptly correct any reported inaccuracies. Insurers must also assist members in locating behavioral health services when in-network providers are not available in a timely manner.

Provider Impact

Providers should ensure directory information is accurate, including:

• Practice location
• Specialty
• Contact information
• Accepting-new-patients status

Plans may increase outreach to confirm directory data and availability.

What Providers Should Do

• Respond promptly to directory verification requests.
• Notify us of changes to practice status, locations, or panel availability.
• Behavioral health providers may see increased requests for single-case agreements when network access gaps occur.
• Respond within 15 business days to an insurer's request to verify the accuracy of directory information.

Link to Bill

H.B. 258 – INSURANCE COVERAGE AMENDMENTS

H.B. 258 establishes parity between coverage for gender transition treatments and reversal procedures. If a health plan covers hormonal or surgical treatments related to gender transition, it must also cover treatments used to reverse those procedures. The requirement would apply to health benefit plans issued or renewed on or after January 1, 2027.

Link to Bill

H.B. 468 – MOBILE MAMMOGRAPHY AMENDMENTS

H.B. 468 requires health benefit plans that cover mammography screenings to also cover screenings performed by FDA-accredited mobile mammography units in rural areas of Utah. Reimbursement for mobile screenings must match the plan's in-network rate, and services must follow USPSTF guidelines on age and frequency. This requirement takes effect January 1, 2027.

• Mobile mammography units must be accredited by an FDA-designated accrediting body to qualify for coverage.
• Reimbursement will be at the plan's standard in-network mammography rate.
• Rural-area providers should communicate this expanded benefit to eligible patients.

Link to Bill

S.B. 175 – HEALTH INSURANCE REVISIONS (AUTISM-RELATED INSURANCE PROVISIONS)

S.B. 175 focuses on amending definitions and creating a reporting requirement related to autism insurance coverage. The bill updates terminology and mandates reporting on autism-related metrics by health benefit plans.

Link to Bill

S.B. 204 – PHYSICAL THERAPY PAYMENT AMENDMENTS

S.B. 204 requires insurers to apply the same cost-sharing structure used for primary care to physical therapy services, reducing the financial burden on patients seeking physical therapy care.

Provider Impact

Patients covered under applicable regulated plans, such as fully insured and individual plans, will now be subject to primary care cost-sharing for physical therapy services. This change may increase patient volume, as lower out-of-pocket costs often result in patients completing more of their prescribed treatment plans rather than discontinuing care early.

Link to Bill

S.B. 319 – HEALTH INSURANCE PRIOR AUTHORIZATION AMENDMENTS

S.B. 319 introduces new updates to the current preauthorization framework, focusing on insurer transparency, decision-making timelines, AI disclosure, and continuity-of-care requirements. A summary of the key provisions:

• Requires insurers to post preauthorization criteria and requirements on their public website.
• Adds a definition of urgent care services.
• Requires insurers to disclose whether they use artificial intelligence (including generative AI) during preauthorization reviews.
• Establishes decision timelines: seven calendar days for standard requests and 72 hours for urgent requests.
• Requiring disclosure if artificial intelligence is used in reviewing authorization requests.
• If an insurer receives an urgent care request but lacks the information needed to make a decision, the insurer must promptly notify the network provider, no later than one business day, of the additional information required and allow at least two business days for the provider to supply it. After receiving the additional information, the insurer must issue its decision within two business days.
• Establishing maximum timeframes for authorization determinations.
• Setting minimum authorization validity periods for authorization determinations:
  • At least 12 months for chronic or long-term conditions.
  • At least 6 months for outpatient services.
• Expanding reporting requirements for prior authorizations.
• Patients with chronic conditions on stable, established treatment plans will be protected from repetitive reauthorization cycles.
• Continued monitoring of these legislative developments by our team.

Link to Bill

We are committed to keeping you informed as these laws are implemented. If you have questions about how any of these changes affect your practice, please reach out to your Network Service Representative.